Document Type : Original Article


1 Department of Community Medicine Liaquat National Hospital and Medical College, Karachi, Pakistan

2 Department of Medicine Basic Health Unit, Ahmad Naich Institute, Bahawalpur District Health Authority, Bahawalpur, Pakistan


BACKGROUND: The growth in the elderly population is predicted to expand exponentially and
developing countries like Pakistan have about two‑third of the global elderly population. It is vital to
maintain the health of the elderly aged population to reduce disabilities and health‑care cost.
AIM: This study aimed to determine the health promotion practices among the older aged population
in Pakistan and to explore the factors associate with adopting healthy lifestyle practices.
MATERIALS AND METHODS: This was a cross‑sectional study spanning from 2019 to 2020
conducted on 317 participants of age more than 60 years in Pakistan. The participants included
healthy attendants of patients visiting the outpatient clinics of different disciplines in the Liaquat
National Hospital Karachi through purposive sampling technique. The health‑promoting practices
were assessed using Health‑Promoting Lifestyle Profile II Questionnaire. The factors that determined
the healthy practices among the elderly population were identified using independent t‑test and
analysis of variance and Tukey test, with a significance level of P < 0.05. IBM SPSS Statistics 22
was used for data entry and analysis.
RESULTS: The highest subscale was detected from interpersonal relationships and spiritual growth.
The lowest score was detected from physical activity. The scores differed significantly by occupation,
education, and the marital status of the participants. Females, unmarried people, those who were
less educated, and participants relying on others for financial support had lower health‑promoting
lifestyle scores.
CONCLUSION: The overall health‑promoting practices were good among the old‑aged population of
Pakistan. These practices differed particularly for physical activity, spiritual growth, and interpersonal


  1. United Nations, Department of Economic and Social
    Affairs, Population Division. World Population Ageing
    2017‑Highlights (ST/ESA/SER.A/397); 2017. Available
    publications/pdf/ageing/WPA2017_Highlights.pdf. [Last
    accessed on 2021 Mar 23].
    2. WHO. 10 Facts on Ageing and Health. Available from: http:// [Last accessed on
    2020 Dec 18].
    3. United Nations, Department of Economic and Social Affairs,
    Population Division. World Population Ageing 2019:
    Highlights (ST/ESA/SER.A/430); 2019. Available from: https://
    pdf/ageing/WorldPopulationAgeing2019‑Highlights.pdf]. [Last
    accessed on 2021 Mar 23].
  2. 4. He W, Goodkind D, Kowal P. U.S. Census Bureau, International
    Population Reports, P95/16‑1, An Aging World: 2015, U.S.
    Washington, DC: Government Publishing Office; 2016. Available
    publications/2016/demo/p95‑16‑1.pdf. [Last accessed on
    2021 Mar 22].
    5. HelpAge Global Network. Available from: https://ageingasia.
    org/ageing‑population‑pakistan/.[Last accessed on 2021 Mar 22].
    6. Flint B, Tadi P. Physiology, aging. In: StatPearls. Treasure
    Island, FL: StatPearls Publishing; 2021. Available from: https:// [Last updated
    on2020 Dec 02].
    7. Harridge SD, Lazarus NR. Physical activity, aging, and
    physiological function. Physiology (Bethesda) 2017;32:152‑61.
    8. Vidovićová L. New roles for older people. Pop Ageing 2018;11:1‑6.
    9. National Institute of Population Studies (NIPS)[Pakistan] and ICF.
    Pakistan Demographic and Health Survey 2017‑18. Islamabad,
    Pakistan, and Rockville, Maryland, USA: NIPS and ICF; 2018.
    10. World Health Organization. World Report on Ageing
    and Health. Geneva: World Health Organization; 2015.
    Available from:
    handle/10665/186463/9789240694811_eng.pdf; jsessionid=C7F
    679E7A8793BAF9B0AFF5C5AC674E6?sequence=1.[Last accessed
    on 2020 Nov 05].
    11. Ashiq U, Asad AZ. The rising old age problem in Pakistan. J Res
    Soc Pak 2017;54:325‑33.
    12. The Liaquat National Hospital. Available from: https://www. [Last accessed on 2021 Mar 22].
    13. Walker S, Hill‑Polerecky DM. Psychometric evaluation of
    health promoting lifestyle profile II. Lincoln: Unpublished
    manuscript, University of Nebraska Medical Center, College
    of Nursing; 1997. Available from; https://deepblue.lib.umich.
    pdf?sequence=2. [Last accessed on 2019 Nov 16].
    14. Lee MK, Oh J. Health‑related quality of life in older adults: its
    association with health literacy, self‑efficacy, social support, and
    health‑promoting behavior. Healthcare (Basel) 2020;8(4):407. Doi:
    15. Golinowska S, Groot W, Baji P, Pavlova M. Health promotion
    targeting older people. BMC Health Serv Res 2016;16 Suppl 5:345.
    16. Perelli‑Harris B, Hoherz S, Addo F, Lappegård T, Evans A,
    Sassler S, et al. Do marriage and cohabitation provide benefits to
    health in mid‑life? The role of childhood selection mechanisms
    and partnership characteristics across countries. Popul Res Policy
    Rev 2018;37:703‑28.
    17. Chen Y, Yang C, Feng S. The effect of social communication on
    life satisfaction among the rural elderly: A moderated mediation
    model. Int J Environ Res Public Health 2019;16(20): 3791. Doi:
    10.3390/ijerph 16203791
    18. Jackson BR, Bergeman CS. How does religiosity enhance
    well‑being? The role of perceived control. Psycholog Relig
    Spiritual 2011;3:149‑61.
    19. DuggalD, Sacks‑ZimmermanA, LibertaT. The impact of hope and
    resilience on multiple factors in neurosurgical patients. Cureus
    20. MacLeod S, Musich S, Hawkins K, Alsgaard K, Wicker ER.
    The impact of resilience among older adults. Geriatr Nurs
    21. Bukman AJ, Teuscher D, Feskens EJ, Baak MAV, Meershoek A,
    Renes RJ.Perceptions on healthy eating, physical activity and
    lifestyle advice: Opportunities for adapting lifestyle interventions
    to individuals with low socioeconomic status. BMC Public Health
    2014;14:1036. [doi: 10.1186/1471‑2458‑14‑1036].
    22. Gomes M, Figueiredo D, Teixeira L, Poveda V, Paúl C,
    Santos‑Silva A, et al. Physical inactivity among older adults across
    Europe based on the SHARE database. Age Ageing 2017;46:71‑7.
    23. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M,
    Mohebbi B. A problem‑based learning health literacy intervention
    program on improving health‑promoting behaviors among girl
    students. J Educ Health Promot 2019;8:251.
    24. Guddal MH, Stensland SØ, Småstuen MC, Johnsen MB,
    Zwart JA, Storheim K. Physical activity and sport participation
    among adolescents: Associations with mental health in
    different age groups. Results from the Young‑HUNT study:
    A cross‑sectional survey. BMJ Open 2019;9 (9):E028555. [doi:
    25. Saber F, Shanazi H, Sharifirad G, Hasanzadeh A. Checking the
    determinants of physical activity based on the theory of planned
    behavior in the housewives. J Educ Health Promot 2014;3:94.
    26. National Research Council (US) Panel on Statistics for an
    Aging Population; Gilford DM, editor. The Aging Population
    in the Twenty‑First Century: Statistics for Health Policy.
    Washington (DC): National Academies Press (US); 1988. Available
    10.17226/737. [Last accessed on 2021 May 07].